Is Surgical Culture Changing?

As a new generation enters surgery and as the number of women in the field is (slowly) increasing, one could hope that this also changes surgical culture. But does it? Judith Belle Brown and colleagues asked themselves exactly this question and conducted an interview study with academic surgeons.

Despite the fact that women still reported more struggles to achieve a good work-life-balance, participants overall noted that surgical culture was indeed changing and that surgeons were no longer expected to devote every waking hour to their jobs. For example, one participant noted: “I think things have changed over the years…I mean surgery in the past has been you just work hard, this is your life, and I think it’s changing a little bit … you are allowed to have a life outside. I think that’s good.”

Moreover, participants stated that this change did not only affect attitudes towards work-life-balance in general, but also attitudes towards childcaring responsibilities. One surgeon said: “I think the younger male colleagues, like my generation, it’s a bit different. We’re seeing more and more male surgeons who are doing more stuff at home … and they’re also having to leave early to pick up their kids because their wife is working too… So it’s changing. It’s not like how it used to be, 20 or 30 years ago.”

So let’s hope that these changes prevail!

Advertisements

What matters to female and male medical students?

In order to address the under-representation of women in surgery it is important to understand what female medical students deem important in their future careers. Do they value the same things as their male counterparts and just don’t think that they can achieve those goals in a surgical career or are they actually looking for different things in their careers? A study by Nancy Baxter and colleagues suggests that the latter is the case.

They sent out a questionnaire to Canadian medical students and found that men and women named different factors as important for choosing their specialty. Women placed more importance on the availability of part-time work and parental leave as well as residency conditions, while men valued technical challenge, prestige and earning potential. As both male and female students agreed that surgeons earn a lot of money but do not have high quality family lives, it is not surprising that of the participants, men were more likely to choose surgery as the specialty they were pursuing or considering to pursue.

This study once again highlights two facts: First, it is important to make surgery a career in which family related goals can be achieved by both men and women, and second, the fact that a family and a career in surgery can be combined needs to be communicated effectively to medical students.

Marriage, Children and Happiness at Work

Work-life-balance or the anticipated and actual lack thereof is a widely cited cause for the under-representation of women in surgery. This is especially true for women who have a family or are planning to have one as women continue to carry most of the weight when it comes to childcare and household chores.

A study by Sullivan and colleagues investigates this issue in a large sample of surgical residents in the US. They found that generally married residents and those with children have the highest levels of work satisfaction. However, this difference was driven by male participants. As expected, female residents reported high levels of stress regarding home life as well as finances when they were married or had children.

These results once again stress that while creating equal opportunities at work is important, it is not enough to tackle gender inequality. As long as women continue to be responsible for more family related work, it is thus crucial to go beyond that and provide them with opportunities to combine both work and family and still achieve a good work-life-balance.

The Impact of Work Hour Restrictions in Surgery

Surgery is a time demanding job and that is indeed one of the reasons cited by female and male medical students alike of why they are not interested in going into surgery. While many people argue that long work hours are necessary to avoid frequent handoffs of care and loss of information, others point out that long work hours are detrimental for both physical and mental health and can lead to additional errors.

A study speaking to this issue comes from the US, where Matthew Hutter and colleagues investigated the effects of mandated restrictions in the work hours of surgical residents. Notably, we are not talking about restrictions that would make their work hours “normal” by any regular-work-person standards. Their work was restricted to 80 hours a week. But even so, they found effects after the changes were implemented including decreased burnout and increased quality of life. However, participants also voiced concerns about reduced quality of care.

These issues are of course also important for part-time work, which seems to be an option that many women in surgery would like to opt for. So how can the same benefits be achieved while maintaining a high quality of care for patients?

Obstacles for Women in Pediatric Surgery

Just as any are within surgery, pediatric surgery struggles to recruit women. But what might be some of the barriers women in this field face and how do they influence job satisfaction? In order to investigate this issue, Donna Caniano and colleagues sent out a questionnaire to 95 female pediatric surgeons in the US.

They found that, in line with what female medical students might fear, women in pediatric surgery did express a desire to spend more time with their families and more room for personal interests in their lives. This is obviously an important issue which needs to be addressed. Offering part-time work may be an option and about half of participants showed interest in reduced hours. Moreover, about a third of female pediatric surgeons expressed interest in fixed-time schedules. However, women working in academic surgery were concerned that this would interfere with their career.

On a more positive note, regardless of these issues most women reported high career satisfaction, perceived their career to be rewarding and would make the same career choice again. Nevertheless, the issues raised above need to be addressed in pediatric surgery, but also in surgery in general.

Are Female Doctors With Young Children Less Motivated?

No. No they aren’t. Although it is often claimed that career motivation suffers from having children – at least for women – a study by Berber Pas and colleagues from the Netherlands finds that this is not necessarily the case. Neither being a mother nor the age of the youngest child significantly predicted career motivation.

What did matter, however, was one’s view on motherhood. Those who had more traditional views on what a mother ought to be (e.g. spending most of their time with their children) were less motivated than those who had more modern views on this issue. Moreover, a supportive work environment – especially supervisor’s support for one’s career goals – was beneficial for career motivation of female doctors.

This clearly shows that the negative attitude of some employers towards working mothers – or those who might one day become mothers – is quite unwarranted. Instead, it is important to focus on supporting female doctor’s career goals and changing unrealistic expectations of what a “good mother” is.

More on Work-Life-Balance in Surgery

Juggling a successful career in surgery and your life outside of work can be challenging. However, it is not impossible. Here is what those working in surgery have to say about their work-life-balance:

“My children strike my work-life-balance for me. So the best thing I could have done for a work-life-balance is have a family, so that I know that I have to go home. And as soon as I open that front door, unless there is a major catastrophe at work, it all just completely melts away. And suddenly it’s geography homework or parents evening or I haven’t got anything to wear for Phoebe’s party on Friday and neurosurgery becomes a distant memory until the next day starts.”

“What do I enjoy doing? Cooking and having people over for dinner. Being a hostess as well as going out for dinner. And sort of de-stressing by that. I go to the gym, I get whipped into shape by my twin sister and try to go swimming and that sort of thing. I do enjoy spending time with the children and getting dragged to lighthouses and Roman forts by my husband. So I definitely do enjoy the time with the children and the family because it sort of keeps you sane. Work is one thing, but you have to sort of counterbalance that.”

“I’m catholic so I’m quite involved with my church and I am part of a couple of groups and we meet monthly, so that is a big part of my life. And I really like singing, particularly in groups, so I’m well known for dragging unwilling people to piano bars in whatever city we’re in for our research.”

 

If you want some more advice on this issue, check out our previous post on the topic.

Gender Equality of Surgeons at Home

There are a number of studies about gender differences of surgeons out there – but are there gender differences in surgeons’ spouses? Although we have never asked ourselves this question before, we stumbled across a survey which investigated just this and thought it quite interesting. After all, spousal support is without a doubt an important factor in career satisfaction or life satisfaction more generally.

Interestingly, there was no gender difference in percentage of respondents who had children or in number of children. The myth of the childless career woman thus seems to be just that – a myth. There was, however, a gender difference in whether or not spouses had a job outside of the home. While 88% of male spouses worked outside of the home, only 55% of female spouses did so. Both male and female spouses indicated that they would be happier if their spouse worked less. Maybe unsurprisingly female spouses indicated that they carried most of the responsibilities for home and childcare whereas this was not the case for male spouses – and this held true regardless of the working hours of the spouse. This is problematic, as it indicates that female surgeons have an overall higher workload than their male counterparts – and while a number of initiatives aim at improving work conditions for women at work, the differential work load outside of the workplace remains largely unaddressed.

Work-Life-Balance and Burnout in Female and Male Hospital Doctors

As women continue to carry a larger part of the responsibilities regarding housekeeping and childcare, it is not surprising that they generally find it harder to achieve satisfactory levels of work-life-balance in occupations that are generally associated with long working hours such as medicine. A recent survey study looked at how the perception of hospital doctors’ work-life-balance was related to burnout and intentions to quit their job and how whether this depended on gender.

The author found that work-life-balance was the most important predictor of burnout and that support from superiors and co-workers as well as working in a family friendly environment significantly lowered burnout. Interestingly, support from co-workers was the most important factor for female doctors, whereas support from one’s superiors and working in a family friendly work environment was more important for male doctors. Similarly, work-life-balance and support for co-workers were related to female but not male doctors’ intentions to quit, while working on a rota working pattern was predictive of male but not female doctors’ intentions to quit. Overall, women also reported higher levels of burnout.

This is interesting, as it shows that reducing burnout and retaining skilled doctors, might be achieved quite differently for men and women. It also shows that the fact that women are still responsible for the majority of domestic tasks is reflected in their higher need for a work-life-balance and that this issue needs to be addressed, both at and outside of the workplace.

Some More Advice for Future Surgeons

After a positive response to our first post about advice to future surgeons, we have put together another selection of quotes from people working in surgery, which we hope you will find helpful.

“You need to be hard-working, dedicated. You don’t need to be particularly academic or into research, you just need to work hard and be prepared to put the hours in. If you are, then you’ll get far. You have to have a balance of work and life and you will have to make sacrifices. If you are prepared to do that, then it will be fine – and it is definitely worth it. I can’t imagine doing anything else and I don’t want to do anything else, so I’m quite happy to make a sacrifice here and there. When you are a more junior trainee, it is a little bit more difficult with the hours that you have to work, but as you get a bit more senior… I’ve found that I have a great work-life-balance. I still go on holidays, I still go out with my friends all the time. I just watch less TV, so I can get my work done during the week and then have fun on the weekends.”

“It is not an instant glorification career. It’s a marathon run rather than a sprint. It’s not glamorous on a day-to-day basis like you see portrayed on television, but it is doable and workable and if you are prepared to put in the hard work, it is a very rewarding career to have.”

“It is a lifestyle choice, but it is a lifestyle choice I knew I was getting into and I absolutely love it and there is nothing like the buzz you can get when you have done something and you have done it well.  So how do you get a good work-life-balance? I think you have to have really understanding friends and really understanding family and you have to be really organized. People say ‘Oh, I bet you don’t get to do very much’, but actually I think I do more because I plan everything meticulously, so in my spare time I actually do something all the time and I am making time for people. I think it is easy. I do have lots of hobbies. If you want to fit stuff in, you just do it.”